Injectable contraceptives, particularly those that are discreet and highly effective, have long been popular in Sub-Saharan Africa. Among these, the subcutaneous formulation of DMPA (DMPA-SC), known by the brand name Sayana Press, stands out. This method can be administered by community health workers (CHWs) and by clients themselves. Globally endorsed and proven safe and effective, DMPA-SC for self-injection has been added as a “strong recommendation” by the WHO. In Ethiopia, it has been approved by the Ethiopian Food and Drug Administration (EFDA) and is poised to revolutionize contraceptive options for women.
In Ethiopia, DMPA-SC is currently available through limited private health facilities as a provider-administered injection. Recognizing its potential, the MoH, with support from EPHI and FHI 360, conducted an implementation research study in 2021. This study, involving 400 women from six public health centers in Addis Ababa, assessed the safety, acceptability, and feasibility of DMPA-SC self-injection. The findings were promising: 95.3% of participants could safely self-inject during enrollment, and 83.1% continued to do so at follow-up. High satisfaction rates (84%) and willingness to recommend the method (85%) further underscored its potential impact.
The MoH envisions a phased-based introduction of DMPA-SC for self-injection across Ethiopia, aiming to integrate it into the broader FP method mix. The objectives include expanding FP options through public service delivery channels, piloting the method in diverse settings, ensuring consistent supply and commodity security, and integrating DMPA-SC into national FP programs for sustainable monitoring and scale-up.
The introduction plan is structured to ensure systematic integration into existing service delivery systems, including training, supervision, and monitoring. The phased approach begins with major cities and urban settings, followed by semi-urban contexts, and finally, pilot studies in agrarian and pastoralist regions. This structured rollout is designed to address specific needs and contexts of different regions in Ethiopia.
Advocacy efforts will align with national FP communication guidelines to create a supportive policy environment. Key objectives include increasing contraceptive options, engaging decision-makers for resource mobilization, and raising awareness through diverse media channels. By fostering an environment that supports DMPA-SC self-injection, the initiative aims to empower women and enhance self-care practices.
Service delivery will target pre-identified facilities with high FP service demand. Comprehensive counseling on contraceptive options will be provided, and both new and current DMPA-IM users will be informed about DMPA-SC and SI options. Training will adopt a cascade approach, starting with master trainers and extending to FP service providers at various levels. The MoH will also integrate DMPA-SC training materials into pre- and in-service training curricula.
Proper storage and waste management practices are crucial for DMPA-SC. Clients will be trained to store units safely and dispose of used needles properly. The supply chain management plan aims for accurate stock monitoring and timely procurement, leveraging Ethiopia’s existing FP commodity distribution platform.
Targeted SBCC will play a vital role in raising awareness and addressing myths about DMPA-SC/SI. Mass and social media campaigns, community dialogues, and facility-level education will ensure informed choices and increased demand for FP services. Engaging men in FP discussions and ensuring provider readiness are also integral components of the SBCC strategy.
The Ethiopian Society of Obstetricians and Gynecologists (ESOG) will play a pivotal role in this endeavor. ESOG will engage in advocacy, training, and awareness campaigns to support the introduction and scale-up of DMPA-SC self-injection. By collaborating with policymakers, healthcare providers, and communities, ESOG aims to ensure that every woman in Ethiopia has access to safe, effective, and self-administered contraceptive options. Through these efforts, ESOG is committed to advancing women’s health and empowerment across Ethiopia.
This transformative initiative represents a significant step towards improving contraceptive access and empowering women in Ethiopia, aligning with broader goals of gender equity and universal health coverage.